<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Apply_no')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-apply_no" class="form-control form-control" name="row[apply_no]" type="text" value="{$row.apply_no}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Box_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-box_id" data-rule="required" data-source="box/index" class="form-control selectpage form-control" name="row[box_id]" type="text" value="{$row.box_id}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Box_no')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-box_no" class="form-control form-control" name="row[box_no]" type="text" value="{$row.box_no}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('User_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-user_id" data-rule="required" data-source="user/user/index" data-field="nickname" class="form-control selectpage form-control" name="row[user_id]" type="text" value="{$row.user_id}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Province')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-province" class="form-control form-control" name="row[province]" type="number" value="{$row.province}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Province_name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-province_name" class="form-control form-control" name="row[province_name]" type="text" value="{$row.province_name}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('City')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-city" class="form-control form-control" name="row[city]" type="number" value="{$row.city}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('City_name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-city_name" class="form-control form-control" name="row[city_name]" type="text" value="{$row.city_name}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Area_name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-area_name" class="form-control form-control" name="row[area_name]" type="text" value="{$row.area_name}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Area')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-area" data-rule="required" class="form-control form-control" name="row[area]" type="number" value="{$row.area}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Quarters_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-quarters_id" data-rule="required" data-source="quarters/index" class="form-control selectpage form-control" name="row[quarters_id]" type="text" value="{$row.quarters_id}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Unit_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-unit_id" data-rule="required" data-source="unit/index" class="form-control selectpage form-control" name="row[unit_id]" type="text" value="{$row.unit_id}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Room_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-room_id" data-rule="required" data-source="room/index" class="form-control selectpage form-control" name="row[room_id]" type="text" value="{$row.room_id}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Address')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-address" class="form-control form-control" name="row[address]" type="text" value="{$row.address}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Contacts')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-contacts" class="form-control form-control" name="row[contacts]" type="text" value="{$row.contacts}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Telephone')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-telephone" class="form-control form-control" name="row[telephone]" type="text" value="{$row.telephone}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Remark')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-remark" class="form-control form-control" name="row[remark]" type="text" value="{$row.remark}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Status')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-status" data-rule="required" class="form-control form-control" name="row[status]" type="number" value="{$row.status}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Place_time_start')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-place_time_start" class="form-control datetimepicker form-control" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[place_time_start]" type="text" value="{$row.place_time_start|datetime}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Place_time_end')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-place_time_end" class="form-control datetimepicker form-control" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[place_time_end]" type="text" value="{$row.place_time_end|datetime}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Recovery_time_start')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-recovery_time_start" class="form-control datetimepicker form-control" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[recovery_time_start]" type="text" value="{$row.recovery_time_start|datetime}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Recovery_time_end')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-recovery_time_end" class="form-control datetimepicker form-control" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[recovery_time_end]" type="text" value="{$row.recovery_time_end|datetime}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Recovery_reason')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-recovery_reason" class="form-control form-control" name="row[recovery_reason]" type="text" value="{$row.recovery_reason}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Refusal_reason')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-refusal_reason" class="form-control form-control" name="row[refusal_reason]" type="text" value="{$row.refusal_reason}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Refusal_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-refusal_time" class="form-control datetimepicker form-control" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[refusal_time]" type="text" value="{$row.refusal_time|datetime}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Audit_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-audit_time" class="form-control datetimepicker form-control" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[audit_time]" type="text" value="{$row.audit_time|datetime}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
